Clinicians Who Inspire – Rhiannon Haynes, COTA/DOR – April 2023

This month we had the privilege of speaking with Rhiannon Haynes, COTA and DOR, Champion Level I, at Envive Healthcare of Hartford City, to share some insight and inspiration from clinicians in the field. As we discussed treatment interventions and interdisciplinary communication, it was evident that Rhiannon brings “good vibes only” everywhere she goes.

Rhiannon encourages therapists to have no fear in thinking outside the box, trying new things, and reaching out to colleagues when it comes to providing the best treatment for residents. She shared the importance of humor, positivity, and patient-centered goals to motivate residents to not only participate, but also enjoy their therapy sessions. Recently, the therapists at Hartford City have incorporated the use of ‘Alexa’ in their therapy gym. Whether it be to play music during exercise, practice communication skills with Q&A, or to catch up on the week’s weather forecast, it has proven to bring something extra to therapy. Rhiannon also shared that holiday groups to create crafts and door decorations help brighten the halls of their community.

The staff at Rhiannon’s facility share the common goal of being there for one another so that ultimately, they can be their best for their residents. She spoke of the interdisciplinary team as a “family unit” that values each person’s role in overall cohesion and communication. “We all talk to one another with openness and common respect. We treat each other how we want to be treated, and that makes it easy for good vibes.”

Rhiannon- thank you for sharing your good vibes with your residents, your “family unit”, and your therapy peers! You are an inspiration, and your care matters!

Clinicians Who Inspire – Richa Kohli, PT – March 2023

Richa Kohli, PT has worked in several different settings and with various patient populations. For the last 7 years, Richa has worked solely with geriatrics which is unequivocally her favorite. When it comes to providing physical therapy (PT) to geriatrics, Richa states it’s all about “being patient.” Richa, who also has a Master’s Degree in Clinical Psychology, says that when she intently listens to her patients they reciprocate and are more prone to listen to what she has to tell them in relation to PT. Richa also spoke of how important it is to make treatment personal and to take into consideration what the patient wants to do. Embracing what your patient needs or wants helps to avoid treatment becoming mundane.

Richa talked greatly about the fun group activities that her team is a part of. They partner twice a week with activities for group and find that this interdisciplinary approach allows for better coordination and participation.  

As the sole PT in her facility, Richa doesn’t miss a chance to encourage her peer therapists to broaden their knowledge base. Richa enjoys taking courses on Reliant U and reviewing journal articles to grow her skill set and equip herself with knowledge to provide evidence-based treatment.

Richa, thank you for all you do for your residents and fellow therapists. Thank you for reminding us to always listen empathetically and continue to learn and grow daily to positively impact our patients’ lives. You are an inspiration and your care matters!

Quarterly Confidential Feedback Reports for FY 2024 SNF VBP Program Available

The March 2023 Quarterly Confidential Feedback Reports for the FY 2024 SNF VBP Program are now available to download via the Quality Improvement and Evaluation System (QIES)/Certification and Survey Provider Enhanced Reports (CASPER) reporting system. These reports contain interim stay-level data for the SNF 30-Day All-Cause Readmission Measure (SNFRM) for 10/1/2021 – 6/30/2022 (Quarter 1 – Quarter 3 of FY 2022, the FY 2024 SNF VBP Program performance period). The interim data contained in these reports are not final and are subject to change; thus, they are not eligible for the SNF VBP Program’s Review and Correction process.

CLICK HERE to review the FAQs.

CMS Nursing Home Stakeholder Call on 2/22/23

On February 22, 2023, CMS held a Nursing Home Stakeholder Call as part of a series of calls prior to the end of the PHE on May 11, 2023. Topics discussed included the following:

  • End of the Qualifying Stay and Benefit Waiver – The qualifying hospital (3-day) stay and benefit period (100-day refresh without the 60-day wellness) waivers will end on 5/11/23. Clarifying examples provided indicated waiver application may be applied for qualifying patient whose stay begins on or before 5/11/2023. Stakeholders were reminded that CMS is unable to extend these waivers beyond the PHE, any permanent solution would have to be implemented by congress through legislation.
  • Billing of vaccines under Part B – Billing of vaccines and monoclonal antibodies during a Part A stay under the guise of consolidated billing and excluded under the bundle and billed under Part B will be in effect until June 30, 2023.
  • Vaccination requirements and reporting – Staff vaccinations (primary series only) will continue to be required until 11/5/24 and reporting of vaccinations under NHSN must be completed until 12/21/24.
  • COVID-19 testing requirements – End when the PHE expires; however, nursing homes are still going to be expected to test per CDC standards for infection control and prevention.
  • Staffing study – Data is still being collected and analyzed on the staffing study. CMS is currently reviewing the data to determine what policies will be implemented.  CMS reiterated stakeholders will have ample time to provide feedback on any proposed changes.

Preparing for the End of the PHE Fact Sheets

As we prepare for the end of the Public Health Emergency (PHE) on May 11, 2023, CMS and HHS have released fact sheets to aid in a smooth transition.

The PHE Fact Sheet includes information on

  • COVID-19 vaccines, testing and treatments.
  • Telehealth services.
  • Nurse Aide Training for Nursing Homes.

The LTC Fact Sheet highlights

  • The end of the 3-day prior hospitalization and 60-day wellness period waivers at the end of the PHE.
  • Payment for COVID-19 vaccines and monoclonal antibodies.

The COVID-19 PHE Transition Roadmap outlines flexibilities and processes that will and will not be affected by the end of the PHE.

CMS has agreed to provide additional resources as the end of the PHE nears. Reliant Rehabilitation will continue to keep you updated as new information is released.

 

Clinicians Who Inspire – February 2023 – Dana Marsh

Through the Clinicians Who Inspire series, we continue to share motivation, creativity, and inspiration from clinicians in the field. This month we spoke with Dana Marsh, Champion Level I Therapist, Speech-Language Pathologist and Director of Rehab at Spring Valley Care Center. Dana states, “You’re never going to regret being kind.” Her favorite part of working in long-term care is being able to utilize her speech pathology skillset to improve outcomes with the added bonus of incorporating small acts of kindness that make a huge difference in patients’ lives.

Dana holds regular morning groups (pictured here) where patients are guided through skilled prompting, modeling, and use of compensatory strategies to share current events, games, snacks, and coffee while targeting their speech and language goals.

For clinicians looking to further their knowledge with education courses, Dana recommends Clinical Effects and Considerations of Stroke Based on the Affected Region of the Brain, a Reliant University course she completed that describes common clinical manifestations of stroke based on the affected region of the brain, and discusses the implications on treatment strategies and consideration.

Dana values student internships at her facility from local universities. She enjoys the mentorship opportunities it presents and has even gained additional team members from these placements. Her biggest piece of advice to her clinical colleagues is to work together with all the various departments in the facility. She feels that working together with all departments ensure that everyone feels valued and unified in the overall goal to ensure that patients are receiving the best care. Thank you, Dana, for sharing your passion and creativity with your patients, interdisciplinary team, and therapy peers!

 

HRSA Releases Updates Regarding Period 4 Reporting of COVID-19 Funds

Health Resources and Services Administration (HRSA) released two important updates: 

·         Reporting Period 4 (RP4): Providers who received one or more PRF (General or Targeted) and/or ARP Rural payments exceeding $10,000, in the aggregate, from July 1 to December 31, 2021, must now report on their use of funds. The PRF Reporting Portal opened for RP4 on January 1, 2023, and will remain open through March 31, 2023, at 11:59 p.m. ET. Additional HRSA guidance is available on the PRF Reporting Resources webpage.

·         Phase 4 and ARP Rural Payment Reconsiderations Deadline: Providers who believe their Phase 4 and/or ARP Rural payment was calculated incorrectly have an opportunity to submit a payment reconsideration within 45 days of receiving the notification for their company. For more information, visit the Payment Reconsideration webpage.

SNF Provider Preview Reports Now Available

The Skilled Nursing Facility (SNF) Provider Preview Reports have been updated and are now available. These reports contain provider performance scores for quality measures, which will be published on Care Compare and Provider Data Catalog (PDC) during the April 2023 refresh.

 

The data contained within the Preview Reports are based on quality assessment data submitted by SNFs from Quarter 3, 2021 through Quarter 2, 2022. Additionally, the Centers for Disease Control and Prevention (CDC) COVID-19 Vaccination Coverage among Healthcare Personnel (HCP) measure reflects data from Quarter 2, 2022. The data for the claims-based measures will display data from Quarter 3, 2019 through Quarter 4, 2019 and Quarter 3, 2020 through Quarter 2, 2021 for this refresh, and for the SNF Healthcare-Associated Infections (HAI) measure, from Quarter 4, 2020 through Quarter 3, 2021.

 

Providers have until February 16, 2023, to review their performance data. 

Promoting Mental Health in Long-Term Care

The month of January hosts National Popcorn Day and National Compliment Day among other lighthearted celebrations; however, it is also known to be Mental Wellness month. Before this month comes to an end, let’s take some time to discuss the importance of mental health awareness in long-term care and evaluate current efforts in place to promote mental wellness.

According to a study published by the National Institutes of Health, 65-90% of nursing home residents are affected by a mental health disorder. Furthermore, research tells us that decreased mental health can affect both cognitive and physical functioning, and ultimately, a resident’s quality of life. With this knowledge, it’s not surprising that the Centers for Medicare and Medicaid Services (CMS) recently updated requirements and compliance processes related to mental health services in the long-term care setting. Awareness of the effects of mental health on residents is imperative, but only one piece of the puzzle in the greater picture of optimized mental wellness. Focus on facility processes that facilitate opportunities for residents to feel like their best selves is a key component to success.

Listed below are some practical ways for skilled nursing facilities to promote mental wellness among residents:

  • Maintain connection with friends and family. Provide accessibility to necessary devices for planning and interaction.
  • Increase opportunities for decision-making. Offer choices in meal options, leisure activities, and daily routine.
  • Provide activities to promote physical and mental exercise. Encourage residents to safely participate in memory games, puzzles, and home exercise programs.
  • Encourage social interaction through group activities. Ensure every resident is invited to attend celebrations, group activities, and/or community outings.
  • Implement resident-specific interests in daily life. Promote facility staff awareness of each resident’s motivation and activities of interest.

Reliant strives to serve with you to promote the mental health of residents in your facility. Reach out to your Reliant partners to learn more.

Clinicians Who Inspire – January 2023 – Karla Ashley

Through the Clinicians Who Inspire series, we continue to share motivation, creativity, and inspiration from clinicians in the field. This month we spoke with Karla Ashley, Champion Level I Therapist, occupational therapist and Director of Rehab at Vicksburg Convalescent Home. Through facilitation of resident opportunities for social interaction and participation in activities that stimulate the mind, body and spirit, Karla finds meaning in her every day as a therapist in the skilled nursing facility.

During the interview, Karla discussed some of the fun group therapy activity ideas they have implemented recently at their facility. Dancing groups, indoor/outdoor gardening activities, and an annual Mardi Gras parade—complete with beads, masks, pies, and a king and queen, are just a few of the examples provided. She shared the many benefits and positive outcomes they’ve seen through these groups, including improved balance, coordination, cognition, and morale amongst participants.

Karla shared that though she has worked in various settings throughout her 30-year career, she loves working in the skilled nursing facility setting. “The residents become your family. You’re there with them through it all. Even those that come and go; they come back to us when they need it. They come to love and respect us as much as we love and respect their needs.” Thank you, Karla, for sharing your passion and creativity with your patients, interdisciplinary team, and therapy peers!

Clinicians Who Inspire – December 2022 – Hensen Keetch

Through the Clinicians Who Inspire series, we continue to share motivation, creativity, and inspiration from clinicians in the field. This month we spoke with Hensen Keetch, Champion Level II therapist and physical therapist at Canyon Rim Care Center. Through creativity and recognizing each patient’s individuality, he continues to have an impact in meaningful ways.

During the interview with Hensen, it was noted that he has a deep understanding of person-centered care and brings that into his daily treatment interventions. During group activities, Hensen and the other group participants learned that one patient previously played basketball overseas and another patient was the scorekeeper for the local NBA team. These discoveries led to additional activities, discussions, and connections within groups. He also shared an example of a patient who was a former high school soccer player.  With this knowledge, the team intertwined soccer into treatment; what better way to challenge balance than with passion for the game?  

Hensen knows that interdisciplinary team communication and education are keys to patient success. As an advocate for fall prevention and intervention, he meets with the nursing staff to discuss individualized strategies and plans for fall reduction and recovery after every reported fall. 

Hensen, thank you being a clinician who inspires your patients, the interdisciplinary team, and your therapy peers! 

Clinicians Who Inspire – November 2022 Kristin Jacobson-Messner

Through the Clinicians Who Inspire series, we continue to share motivation, creativity, and inspiration from clinicians in the field. This month we spoke with Kristin Jacobson-Messner, Champion Level I Therapist, SLP and Director of Rehab at Avalon Health Care in Madera. Through her creativity and positive outlook, she continues to have an impact in meaningful ways.

Through creating colorful, personalized memory books; incorporating seasonal treats during dysphagia treatments (e.g., pumpkin pie), or decorating the gym, Kristin strives to keep her interventions person-centered. She also credits the entire team at the facility for having a united attitude when it comes to caring for the residents. Oftentimes, the activities team will collaborate and work with the rehab team to continue with tasks and exercises residents have achieved in therapy, helping to carryover functional gains and compensatory strategies.

For personal growth in her field, Kristin really enjoys participating in CEUs offered through Reliant U. Her favorites are those focused on dysphagia.

Thank you, Kristin and team, for fostering friendships, teamwork, creativity and innovation; and for being clinicians who inspire each other, your patients, and all your therapy peers! 

Clinicians Who Inspire – October 2022 Laura Redd, COTA

Through the Clinicians Who Inspire series, we continue to share motivation, creativity, and inspiration from clinicians in the field. This month we spoke with Laura Redd, COTA/Director of Rehabilitation and Champion Level II therapist at Huntsville Health Care Center. During the interview, she explained that she has always worked in skilled nursing. She was originally employed as a CNA, then worked as a rehabilitation tech for seven years before becoming a COTA and then Director of Rehabilitation. Her unique background has provided insight into how to bridge the gap of communication between therapy and nursing.

Laura is passionate about ensuring patients have as many opportunities as possible for out-of-bed engagement. As a Champion Level II therapist, she provided education to nursing staff concerning the need for residents to be out of bed, not only for therapy, but also for meals and activities as the research supports out of bed activities improve overall wellbeing and quality of life. Her presentation was used to develop a resource for Reliant about the benefits of social interaction and physical activity, click HERE for a glimpse at this resource. She indicated that once all staff understand that the purpose of the patient being out of bed and engaged is “to maintain their functional level and prevent declines”, it becomes ultimately easier for everyone to work toward that goal.

Laura, thank you for all you do for your residents and nursing teammates, advocating for quality patient care, and for being a clinician who inspires your patients and your peers! 

Clinicians Who Inspire – October 2022 Daisy Franklin, PT

When Daisy Franklin, PT, started her career 17 years ago, she was sure pediatrics was the setting for her. That is, until a friend referred her to a SNF, where she took the job and has been at her current facility now for 15 years. Daisy loves her residents and truly enjoys hearing their life experiences while gaining knowledge from them daily.

As DOR and part of the therapy team, Daisy interacts with all facility staff and says they are like one big family. She and most of her co-workers have been in this facility for 5+ years which supports that feeling of family; they have been through a lot together.  

Fun isn’t just reserved for the therapists; Daisy and her co-workers enjoy making therapy fun for the residents too! The residents look forward to the cooking groups hosted by multiple disciplines. Daisy has personally witnessed the benefits group therapy has to offer, including increased socialization and increased peer interaction and support to encourage residents to do their best.

Daisy has achieved Champion Level 1 focusing on wound care. Climbing the Clinical Ladder has allowed her the opportunity to partner with the facility’s wound care physician to address wounds and accelerate the healing process with modalities. After achieving Champion Level 1, Daisy encouraged her peer therapists to pursue their own Clinical Ladder achievements. Daisy hopes to be able to see the whole rehab team ascend the Clinical Ladder and equip them with a plethora of knowledge to treat their patients.

If Daisy had to offer advice to her fellow therapists, she said it would be to practice patience and compassion in conjunction with their professional skills. Daisy, and team, thank you for all do for your residents and fellow therapists. You truly are an inspiration!

A Recipe for Success

Annual regulatory updates from CMS come as no surprise; however, when coupled with significant updates from the CDC we may feel overwhelmed.

Successful implementation of regulatory, survey, federal, and state updates is possible when we implement the following strategies.

  1. BREATHE! – You’re not alone, and change does not have to be a bad thing. As a matter of fact, the new CDC and CMS guidance is leading us into a highly anticipated phase of the pandemic… a new beginning for our patients, visitors, and employees.
  2. Subscribe to CMS and CDC websites to receive fact sheets, FAQs, invites to webinars, and the latest updates.
  3. Know your company structure and departments of expertise. Watch for their guidance and recommendations.
  4. Review policies and procedures to ensure they are compliant with the new guidance.
  5. Consider any information that may need to be communicated to residents, families, and visitors (e.g., updated visitation guidance) and the best method to deliver this information (e.g., posting signage).
  6. Communicate with staff; consider various methods of delivery (email, webinars, in-person meetings).
  7. Assess the effectiveness of your facility’s implementation of new guidance and regulations. For areas needing improvement, make a plan to ensure preparedness.
  8. Connect with Reliant to receive Real Time Memos and the monthly Reliant Reveal newsletter.

In case you missed these recent publications from Reliant, click the links below to review our summaries of recently updated and upcoming regulatory guidance:

Clinicians Who Inspire – August 2022 Cheri Shefler, SLP/DOR

Through the Clinicians Who Inspire series, we continue to share motivation, creativity, and inspiration from clinicians in the field. This month we spoke with Cheri Shefler, Champion Level I Therapist, SLP and Director of Rehab at Willow Springs Rehabilitation and Healthcare Center. Cheri points out that it is important to have a positive environment where the therapy team and the facility staff can share a true camaraderie in order to facilitate a team approach in their patients’ care. She enjoys being a positive spirit and cheerleader for her colleagues.


Cheri explains that it is also important to have time together as a team. Food often wins the heart, so ordering lunch in or bringing favorite dishes to a holiday potluck are a few favorite ways they celebrate and grow as a team.


To fill her own cup, Cheri finds it rewarding to supervise and guide newly graduated SLPs in their Clinical Fellowship Year (CFY), especially those with little to no experience in the skilled nursing setting. She enjoys the fresh ideas and activities that the new and upcoming SLPs bring to the table and also guiding them to develop treatment interventions that are appropriate for each of their patients.


As opportunities open back up, Cheri looks forward to engaging team members and residents in Carnival Day! This day involves setting up carnival activities within the rehab gym and encouraging all patients and caregivers to participate in the fun, including group activities like tossing water balloons. Thank you, Cheri and team, for being clinicians who inspire each other, your patients, and all your therapy peers!

A Path Out of the Pandemic

They say change is the only thing that is constant in life. Over the past two and a half years, long-term care has been immersed in this concept. In searching for a path out of the pandemic we find ourselves facing reroutes associated with COVID re-emergence or various other infection-prevention barriers. But we are now better equipped and prepared for these detours and, with the skilled eye of assessment, can equip our residents and staff with the tools and function to emerge stronger and fortified.

Many residents were inadvertently negatively impacted by the preventative measures put into place during the pandemic, others may be experiencing lingering deficits from having contracted COVID. Their current baselines are likely not the same as their pre-pandemic baselines.  Screening processes must take this into account to ensure attainment of the highest practicable level of independence, thereby promoting confidence in a return to normalcy for residents.

Even though most facility-based activities have resumed, and therapy gyms have reopened, some residents are hesitant to participate due to residual fears related to infection. Given the new, enhanced barrier precautions outlined by CMS, some residents may see these precautions and fear a surge is imminent. To offset this, open communication, assurance, and vigilance in infection prevention and control processes is key. Implementing health literacy interventions to convey information to residents in ways they can comprehend will allay concerns, provide reassurance, and instill confidence in their home environment.

As we navigate these paths, we should step into the moments that allow us to pause, celebrating our collective endurance, cultivating new bonds through shared activities, and discovering moments of inspiration. May we prevail in constructing a hope-filled future with the permanent paths to successful outcomes.

Clinicians Who Inspire – July 2022 Lynne Steeber

Clinicians Who Inspire

Through the Clinicians Who Inspire series, we continue to share motivation, creativity, and inspiration from clinicians in the field. This month we spoke with Lynne Steeber, Champion Level I Therapist, OTR/L and Director of Rehabilitation at Majestic Care of New Haven. Lynne shared that being organized, keeping a goal-oriented mindset, and providing positive feedback to those around her are ways in which she finds success. Lynne touched on what some of the benefits of this communication have looked like at her site, recognizing the importance of being able to work together to identify and meet patient needs to promote their quality of life. She also discussed the importance of open communication and availability to support the facility staff, whether that be to discuss a noted change in a patient, or provide assistance or training, when needed. Thank you, Lynne, for sharing your positive energy with those around you and ensuring that patients receive the care that they need.  

CMS Updates Nursing Home Requirements of Participation Guidance

On June 29, 2022, the Centers for Medicare & Medicaid Services (CMS) issued updates to guidance on minimum health and safety standards that Long-Term Care (LTC) facilities must meet to participate in Medicare and Medicaid. CMS also updated and developed new guidance in the State Operations Manual (SOM) to address issues that significantly affect residents of LTC facilities.

Surveyors will begin using this guidance to identify noncompliance on October 24, 2022.

Key areas of guidance include

  • Requirements for surveyors to incorporate the use of Payroll Based Journal (PBJ) staffing data for their inspections.
    • CMS indicates the believe this will help identify potential noncompliance with CMS’ nursing staff requirements, uncover instance of insufficient staffing, and yield higher quality care. In addition, they state this allows facilities to begin addressing the staffing issues while the new rule making for minimum staffing levels is underway.
  • Requirements for an onsite at least part-time Infection Preventionist (IP) who has specialized training to effectively oversee the facilities infection prevention and control program.
    • CMS believes that the role of the Infection Preventionist (IP) is critical in the facility’s efforts to mitigate the onset and spread of infections. CMS cites the IP role as critical to mitigating infectious diseases through an effective infection prevention and control program.
  • For additional guidance and details, refer to the State Operations Manual and QSO-22-19-NH.

CMS included in memorandum QSO-22-19-NH recommendations related to resident room capacity.  There are no new regulations related to resident room capacity. However, CMS wanted to highlight the benefits of reducing the number of residents in each room given the lessons learned during the COVID-19 pandemic for preventing infections and the importance of residents’ rights to privacy and homelike environment. CMS urges providers to consider making changes to their settings to allow for a maximum of double occupancy in each room and encouraging facilities to explore ways to allow for more single occupancy rooms for nursing home residents.

Additional details can be found in the following CMS documents: QSO-22-19-NH, Press Release, Fact Sheet